Hebrew School Registration We are thrilled you have decided to entrust us with your child’s Jewish education. We look forward to a fantastic year! Sundays, 9:30 am - 11:30 am $770 Registration fee + $100 material fee = $870 Ready to dive into CTeen or start your Bar/Bat Mitzvah journey? Tap below to join the fun! Note: Students entering Grades 6-7 will participate in the Bar/Bat Mitzvah program. STUDENT INFORMATION How many children are you registering?* up to 3 Your Name* Parent Submitting First Name Last Name Child 1 Full Name* First Name Last Name Hebrew name* Date of Birth* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Gender* BoyGirl School* Grade entering* Please selectKindergarten/PreK 1st2nd3rd4th5th Previous Jewish Education* YesNo Where?* Second Child Child 2 Full Name* First Name Last Name Hebrew Name* Date of Birth* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Gender* BoyGirl School* Grade entering* Please selectKindergarten/PreK 1st2nd3rd4th5th Previous Jewish Education* YesNo Where?* Third Child Child 3 Full Name* First Name Last Name Hebrew Name* Date of Birth* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Gender BoyGirl School* Grade Entering* Please selectKindergarten/PreK 1st2nd3rd4th5th Previous Jewish Education* YesNo Where?* Please describe your family's Jewish background/education (if applicable). Is the biological mother of the Child(ren) Jewish?* YesNo Did the child(ren), their biological mother, or biological grandmother undergo any conversion process or adoption?* YesNo Please provide details* Indicate names if submitting for multiple children Do/Does your child(ren) have any allergies or special medical considerations?* YesNo Please describe them and indicate special precautions or care needed.* Indicate names if submitting for multiple children Do/Does your child(ren) have an IEP or receive any behavioral or educational support in school? (Sharing this information with us enables us to create a Hebrew School environment in which your child(ren) can thrive)* YesNo Please explain* Indicate names if submitting for multiple children PARENTS' INFORMATION Father's Name* First Name Last Name Father's Hebrew Name* Father's Cell* Area Code Phone Number Father's E-mail* Occupation* Mother's Name* First Name Last Name Mother's Hebrew Name Mother's Cell* Area Code Phone Number Mother's E-mail* Mother's Occupation* I would love to be a part of my child’s Jewish education. Please feel free to contact me if there are any opportunities to get involved. I would like to receive news and updates by email. Home Phone* Address* Please indicate your apartment/unit number if applicable. Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Synagogue affiliated with (if any): How did you hear about us? EMERGENCY CONTACT Persons to be contacted in case of an emergency when parents cannot be reached. Please provide two contacts. Contact 1* First Name Last Name Phone Number* Relationship to child* Contact 2* First Name Last Name Phone Number* Relationship to child* TUITION AGREEMENT *To enroll your child(ren) in Chabad Hebrew School, all forms must be completed and sent in to the school. Your application will not be processed without the required forms and fees. *Full payment, or a payment plan must be set up by the beginning of the school year. Payment plans: 2 Installments | 1st payment - upon submission, 2nd payment - charged on 1 November 2024 4 Installments | 1st payment - upon submission, 2nd payment - charged on 1 November, 2024, 3rd payment - January 15, 2025, 4th payment - March 18, 2025 *Enrollment is considered to be for the entire scholastic year. There will be no refunds even if the child is absent due to illness, holidays, vacations and force majeure closure days, or should the parents decide to withdraw the child from the program. *In the event that tuition is not paid, Chabad Hebrew School reserves the right to debit your Credit/Debit card, plus a $25 processing fee. Please check* I understand and agree. RELEASE OF INFORMATION AND PHOTOGRAPHS Parents allow for child(ren)'s picture to be used for internal PR mailing and website and social media accounts where name is not given. Parents allow for child(ren)'s photograph/name released to newspapers where last name will not be given. If not, please contact us. Please check I understand and agree. PAYMENT Registration Fee - $770 Material Fee - $100 I would like to pay* Please selectin fullin two installmentsin four installments I would like to pay* Please selectin fullin two installmentsin four installments I would like to pay* Please selectin fullin two installmentsin four installments Sponsorship opportunities I would like to sponsor a child - $1,250 Payment method* Credit CardOther * Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2024202520262027202820292030203120322033 Expiration YearBilling Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Please check* I authorize Chabad Hebrew School to charge my credit card submitted above for the scheduled charges. Please send payment to: Zelle: [email protected] Venmo: @MidtownChabad Total $5220.00 Yes, I'd like to donate the cost of processing this transaction by adding 3% As the parent(s) or legal guardian of the above child(ren), I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child(ren), I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child(ren) to participate in all school activities, join in class and school trips on and beyond school properties and allow my child(ren) to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes. Please check* I accept. Mother's signature* First Name Last Name Today's date* Month Day Year Father's signature* First Name Last Name Today's date* Month Day Year Submit Clear Form Should be Empty: This page uses TLS encryption to keep your data secure.